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Item #2
New
Physician Guidelines Emphasize Blood Pressure Control in Managing
Diabetes
Aggressive
blood pressure control may be the most important factor in preventing
adverse outcomes in patients with type 2 diabetes.
Because
hypertension, a common problem in patients with type 2 diabetes, is
associated with substantial morbidity and mortality, aggressive
treatment should be a priority, according to guidelines to be released
Tuesday by the American College of Physicians (ACP).
Specifically,
clinicians treating such patients should aim for blood pressures no
greater than 135/80 mm Hg, the guidelines indicate. Achieving this
target "provides dramatic benefits," according to the
findings published in the April 1st issue of the Annals of Internal
Medicine.
"Most
of the focus in diabetes care has been on tight control of blood
sugar," lead author Dr. Vincenza Snow, a senior medical associate
of scientific policy at ACP, said in a statement. "We want both
doctors and patients to know that aggressive blood pressure control is
also important in managing diabetes."
The
guidelines recommend that thiazide diuretics or ACE inhibitors be used
as first-line therapy. In general, these drugs are comparable,
according to the guidelines, but diuretics are the preferred agents
for black patients due to a beneficial effect on stroke and heart
failure rates.
While
these drugs may represent the best initial therapy, the guidelines
emphasize that it is not uncommon for two or more agents to be needed
to achieve target blood pressures.
The
guidelines are based on a review of randomized trials conducted by Dr.
Sandeep Vijan and Dr. Rodney A. Hayward, from the University of
Michigan in Ann Arbor. Eight trials compared blood pressure control
versus placebo or assessed blood pressure targets, and 10 trials
compared the efficacy of different antihypertensive drug classes.
There
is strong evidence that 80 mm Hg is the optimal limit for diastolic
blood pressure, Dr. Vijan and Dr. Hayward note. Although the target
for systolic pressure has not been as rigorously studied, it appears
that maintaining a pressure of 135 mm Hg or less is a reasonable goal.
"Aggressive
blood pressure control may be the most important factor in preventing
adverse outcomes in patients with type 2 diabetes," Dr. Vijan and
Dr. Hayward conclude. Ann
Intern Med 2003;138:587-602.
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FACT:
According to a new study by the U.S. Department of Health
and Human Services, the nation now spends $13,243 on each person with
diabetes, compared to $2,560 for people without the disease.
This represents a direct medical cost of $91.8 billion.
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